Provider Demographics
NPI:1043228091
Name:GUZMAN, JORGE R (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:R
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 HEALTH CENTER BLVD
Mailing Address - Street 2:#2160
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135
Mailing Address - Country:US
Mailing Address - Phone:239-948-4470
Mailing Address - Fax:239-948-0933
Practice Address - Street 1:3501 HEALTH CENTER BLVD
Practice Address - Street 2:#2160
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:239-948-4470
Practice Address - Fax:239-948-0933
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39143Medicare UPIN
FL41632YMedicare PIN